Provider Demographics
NPI:1821197633
Name:MOSS, EDWARD MAURICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MAURICE
Last Name:MOSS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 GLENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-1331
Mailing Address - Country:US
Mailing Address - Phone:215-884-1444
Mailing Address - Fax:
Practice Address - Street 1:950 E HAVERFORD RD
Practice Address - Street 2:SUITE 306
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3850
Practice Address - Country:US
Practice Address - Phone:215-884-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005669L103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist